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Setting up ACOs, Narrow Networks, Integrated Care Networks, or Independent Physician Associations using the Credentialing Process

For the sake of discussion we are going to wrap up these forms of healthcare organizations into the term Managed Network (MN) to include all forms of providing healthcare as a group where the following criteria apply.

Healthcare providers and/or healthcare facilities that may or may not be clinically or financially integrated but band together […]

By |May 11th, 2016|Uncategorized|0 Comments

The Cost of Credentialing

The Cost of Credentialing

Reference:

2004 MGMA Survey “Analyzing the Cost of Administrative Complexity in Group Practice”

2010 Merrit Hawkins Physician Inpatient/Outpatient Revenue Survey

There are two costs associated with the credentialing category of the revenue cycle in the medical field.  We will identify them as internal and external costs.  It’s important to note the costs associated with […]

By |May 10th, 2016|Uncategorized|0 Comments

New CMS Regulations

Over the last two years, CMS has been continually refining its regulations regarding screening to combat Fraud, Waste, and Abuse.  This is in response to several directives laid out for CMS in the Affordable Care Act.

As of now, the regulations are requiring any entity (including “downstream” participants) participating in any federally funded healthcare (Medicare, Medicaid, […]

By |April 15th, 2015|Regulations, Uncategorized|Comments Off on New CMS Regulations